Vigorous exercise, a healthy diet and not smoking may dramatically reduce a man’s risk for aggressive prostate cancer, new research suggests.

Nearly half of lethal prostate cancer cases in the United States would be prevented if men over 60 followed five or more healthy habits, lead author Stacey Kenfield, an assistant professor in the urology department at University of California, San Francisco Medical Center, said in a university news release.

Most cases of prostate cancer do not spread to other parts of the body and are not life-threatening. For some men, however, the disease is deadly, affecting their bones and other organs.

Kenfield’s team investigated whether healthy lifestyle habits could help protect men from aggressive forms of prostate cancer. They analyzed data from two large studies involving more than 62,000 men between 40 and 84. The men, who were cancer-free at the start, were followed for more than 20 years.